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Jung B, Han J, Shahsavarani S, Abbas AM, Echevarria AC, Carrier RE, Ngan A, Katz AD, Essig D, Verma R. Robotic-Assisted Versus Fluoroscopic-Guided Surgery on the Accuracy of Spine Pedicle Screw Placement: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54969. [PMID: 38410625 PMCID: PMC10896625 DOI: 10.7759/cureus.54969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 02/28/2024] Open
Abstract
Spinal fusion is a common method by which surgeons decrease instability and deformity of the spinal segment targeted. Pedicle screws are vital tools in fusion surgeries and advancements in technology have introduced several modalities of screw placement. Our objective was to evaluate the accuracy of pedicle screw placement in robot-assisted (RA) versus fluoroscopic-guided (FG) techniques. The PubMed and Cochrane Library databases were systematically reviewed from January 2007 through to August 8, 2022, to identify relevant studies. The accuracy of pedicle screw placement was determined using the Gertzbein-Robbins (GR) classification system. Facet joint violation (FJV), total case radiation dosage, total case radiation time, total operating room (OR) time, and total case blood loss were collected. Twenty-one articles fulfilled the inclusion criteria. Successful screw accuracy (GR Grade A or B) was found to be 1.02 (95% confidence interval: 1.01 - 1.04) times more likely with the RA technique. In defining accuracy solely based on the GR Grade A criteria, screws placed with RA were 1.10 (95% confidence interval: 1.06 - 1.15) times more likely to be accurate. There was no significant difference between the two techniques with respect to blood loss (Hedges' g: 1.16, 95% confidence interval: -0.75 to 3.06) or case radiation time (Hedges' g: -0.34, 95% CI: -1.22 to 0.53). FG techniques were associated with shorter operating room times (Hedges' g: -1.03, 95% confidence interval: -1.76 to -0.31), and higher case radiation dosage (Hedges' g: 1.61, 95% confidence interval: 1.11 to 2.10). This review suggests that RA may slightly increase pedicle screw accuracy and decrease per-case radiation dosage compared to FG techniques. However, total operating times for RA cases are greater than those for FG cases.
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Affiliation(s)
- Bongseok Jung
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
- Orthopedics, Donald and Barbara Zucker School of Medicine, Hempstead, USA
| | - Justin Han
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | | | - Anas M Abbas
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | | | | | - Alex Ngan
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Austen D Katz
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - David Essig
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Rohit Verma
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
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Butz I, Fernandez M, Uneri A, Theodore N, Anderson WS, Siewerdsen JH. Performance assessment of surgical tracking systems based on statistical process control and longitudinal QA. Comput Assist Surg (Abingdon) 2023; 28:2275522. [PMID: 37942523 DOI: 10.1080/24699322.2023.2275522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
A system for performance assessment and quality assurance (QA) of surgical trackers is reported based on principles of geometric accuracy and statistical process control (SPC) for routine longitudinal testing. A simple QA test phantom was designed, where the number and distribution of registration fiducials was determined drawing from analytical models for target registration error (TRE). A tracker testbed was configured with open-source software for measurement of a TRE-based accuracy metric ε and Jitter (J ). Six trackers were tested: 2 electromagnetic (EM - Aurora); and 4 infrared (IR - 1 Spectra, 1 Vega, and 2 Vicra) - all NDI (Waterloo, ON). Phase I SPC analysis of Shewhart mean (x ¯ ) and standard deviation (s ) determined system control limits. Phase II involved weekly QA of each system for up to 32 weeks and identified Pass, Note, Alert, and Failure action rules. The process permitted QA in <1 min. Phase I control limits were established for all trackers: EM trackers exhibited higher upper control limits than IR trackers in ε (EM: x ¯ ε ∼ 2.8-3.3 mm, IR: x ¯ ε ∼ 1.6-2.0 mm) and Jitter (EM: x ¯ jitter ∼ 0.30-0.33 mm, IR: x ¯ jitter ∼ 0.08-0.10 mm), and older trackers showed evidence of degradation - e.g. higher Jitter for the older Vicra (p-value < .05). Phase II longitudinal tests yielded 676 outcomes in which a total of 4 Failures were noted - 3 resolved by intervention (metal interference for EM trackers) - and 1 owing to restrictive control limits for a new system (Vega). Weekly tests also yielded 40 Notes and 16 Alerts - each spontaneously resolved in subsequent monitoring.
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Affiliation(s)
- I Butz
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - M Fernandez
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - N Theodore
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - W S Anderson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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弥 佳, 周 宇, 冯 前. [A 3D/2D registration method based on reconstruction of orthogonal-view Xray images]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:1636-1643. [PMID: 37814880 PMCID: PMC10563102 DOI: 10.12122/j.issn.1673-4254.2023.09.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To establish a 3D/2D registration method for preoperative CT and intra-operative X-ray images in imageguided spine surgery. METHODS We propose a 3D/2D registration algorithm based on 3D image reconstruction. The algorithm performs 3D image reconstruction of 2D orthogonal view X-ray images, thus converting the problem into 3D/3D registration. By constructing an end-to-end framework that combines the two tasks of reconstruction and registration, the geodesic distance is measured in the 3D manifold space to complete the registration. RESULTS We conducted experiments on the public dataset CTSpine1k. The tests on two test sets with different initial registration errors showed that for data with small initial errors, the proposed algorithm achieved a rotation estimation error of 0.115±0.095° and a translation estimation error of 0.144±0.124 mm; for data with larger initial errors, a rotation estimation error of 0.792±0.659° and a translation estimation error of 0.867±0.701 mm were achieved. CONCLUSION The proposed method can achieve robust and accurate 3D/2D registration at a speed that meets real-time requirements to improve the performance of spine surgery navigation.
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Affiliation(s)
- 佳 弥
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室//广东省医学成像与诊断技术工程实验室,广东 广州 510515School of Biomedical Engineering, Southern Medical University//Guangdong Provincial Key Laboratory of Medical Image Processing//Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
| | - 宇佳 周
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室//广东省医学成像与诊断技术工程实验室,广东 广州 510515School of Biomedical Engineering, Southern Medical University//Guangdong Provincial Key Laboratory of Medical Image Processing//Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
| | - 前进 冯
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室//广东省医学成像与诊断技术工程实验室,广东 广州 510515School of Biomedical Engineering, Southern Medical University//Guangdong Provincial Key Laboratory of Medical Image Processing//Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
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Huang X, Liu X, Zhu B, Hou X, Hai B, Yu D, Zheng W, Li R, Pan J, Yao Y, Dai Z, Zeng H. Augmented Reality Surgical Navigation in Minimally Invasive Spine Surgery: A Preclinical Study. Bioengineering (Basel) 2023; 10:1094. [PMID: 37760196 PMCID: PMC10525156 DOI: 10.3390/bioengineering10091094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In minimally invasive spine surgery (MISS), where the surgeon cannot directly see the patient's internal anatomical structure, the implementation of augmented reality (AR) technology may solve this problem. METHODS We combined AR, artificial intelligence, and optical tracking to enhance the augmented reality minimally invasive spine surgery (AR-MISS) system. The system has three functions: AR radiograph superimposition, AR real-time puncture needle tracking, and AR intraoperative navigation. The three functions of the system were evaluated through beagle animal experiments. RESULTS The AR radiographs were successfully superimposed on the real intraoperative videos. The anteroposterior (AP) and lateral errors of superimposed AR radiographs were 0.74 ± 0.21 mm and 1.13 ± 0.40 mm, respectively. The puncture needles could be tracked by the AR-MISS system in real time. The AP and lateral errors of the real-time AR needle tracking were 1.26 ± 0.20 mm and 1.22 ± 0.25 mm, respectively. With the help of AR radiographs and AR puncture needles, the puncture procedure could be guided visually by the system in real-time. The anteroposterior and lateral errors of AR-guided puncture were 2.47 ± 0.86 mm and 2.85 ± 1.17 mm, respectively. CONCLUSIONS The results indicate that the AR-MISS system is accurate and applicable.
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Affiliation(s)
- Xin Huang
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China;
| | - Xiaoguang Liu
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China;
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; (X.H.); (B.H.)
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Beijing 100052, China;
| | - Xiangyu Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; (X.H.); (B.H.)
| | - Bao Hai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; (X.H.); (B.H.)
| | - Dongfang Yu
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; (D.Y.); (R.L.)
| | - Wenhao Zheng
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; (D.Y.); (R.L.)
| | - Ranyang Li
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; (D.Y.); (R.L.)
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; (D.Y.); (R.L.)
| | - Youjie Yao
- Smart Learning Institute, Beijing Normal University, Beijing 100875, China
| | - Zailin Dai
- Smart Learning Institute, Beijing Normal University, Beijing 100875, China
| | - Haijun Zeng
- Smart Learning Institute, Beijing Normal University, Beijing 100875, China
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Bourret S, Cloche T, Boue L, Thompson W, Dubois T, Le Huec JC. Computed Tomography Intraoperative Navigation in Spinal Surgery: Assessment of Patient Radiation Exposure in Current Practices. Int J Spine Surg 2022; 16:909-915. [PMID: 36153041 PMCID: PMC9926940 DOI: 10.14444/8319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient radiation exposure associated with the use of computed tomography (CT) navigation during spinal surgeries was widely compared with other intraoperative imaging techniques. The aim of this study is to explore the use of navigation with regard to current spinal surgery practices and the technical limitations of such imaging systems. METHODS Dosimetric data from 101 patients who underwent intraoperative, CT-navigated spine surgery were retrospectively collected. The study population was divided into 3 groups according to the primary surgical indication. The number of CT image acquisitions per patient, the field length, and the time of exposure per acquisition during a single surgery were compared as well as the radiation dose emitted to patients. RESULTS Dose-length products (DLP) per acquisition were 678.52, 656.8, and 649.36 mGy·cm with no significant difference for spinal deformity (SD), degenerative disease (DD), and vertebral fracture (VF) procedures, respectively. Analyzing the number of CT image acquisitions per patient revealed that repeated intraoperative scans were often performed for patients who were suffering from an SD due to technical limitations of the navigation. As a consequence, the cumulative dose was higher in the SD group (DLP total = 1175 mGy·cm) than in the DD (DLP total = 762.74 mGy·cm) and VF (DLP total = 649.36 mGy·cm) groups. CONCLUSIONS CT navigation is an efficient intraoperative imaging technique that reduces the rate of surgical complications, but its technical limitations lead to an increased risk of patient radiation exposure, especially for complex surgeries where multiple scanning acquisitions are needed. CLINICAL RELEVANCE To avoid patient's overexposure, spine surgeons should minimize the number of intraoperative acquisitions while considering the complexity of the surgery and the limitations of the guidance system. The use of dual guidance systems has also to be considered according to the benefit-risk balance between patient's outcomes and radiation dose exposure. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Thibault Cloche
- Institut VERTEBRA, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Lisa Boue
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Wendy Thompson
- Institut VERTEBRA, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Thibaut Dubois
- C2isanté, 10 rue Paul Langevin – ZAC Saint Jacques II, Maxéville, France
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Navigation Techniques in Endoscopic Spine Surgery. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8419739. [PMID: 36072476 PMCID: PMC9444441 DOI: 10.1155/2022/8419739] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
Endoscopic spine surgery (ESS) advances the principles of minimally invasive surgery, including minor collateral tissue damage, reduced blood loss, and faster recovery times. ESS allows for direct access to the spine through small incisions and direct visualization of spinal pathology via an endoscope. While this technique has many applications, there is a steep learning curve when adopting ESS into a surgeon's practice. Two types of navigation, optical and electromagnetic, may allow for widespread utilization of ESS by engendering improved orientation to surgical anatomy and reduced complication rates. The present review discusses these two available navigation technologies and their application in endoscopic procedures by providing case examples. Furthermore, we report on the future directions of navigation within the discipline of ESS.
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Charles YP, Cazzato RL, Nachabe R, Chatterjea A, Steib JP, Gangi A. Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Augmented Reality Surgical Navigation for Percutaneous Pedicle Screw Placement. Clin Spine Surg 2021; 34:E415-E424. [PMID: 33560011 DOI: 10.1097/bsd.0000000000001132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective observational study. OBJECTIVE The aim of this study was to evaluate the accuracy of percutaneous pedicle screw placement using augmented reality surgical navigation during minimally invasive transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA Augmented reality-based navigation is a new type of computer-assisted navigation where video cameras are used instead of infrared cameras to track the operated patients and surgical instruments. This technology has not so far been clinically evaluated for percutaneous pedicle screw placement. MATERIALS AND METHODS The study assessed percutaneous pedicle screw placement in 20 consecutive patients who underwent single-level minimally invasive TLIF using augmented reality surgical navigation. Facet joint violation and depression by the inserted pedicle screws were evaluated. Secondary outcome such as radiation dose exposure, fluoroscopy time, and operative time were collected for 3 phases of surgery: preparation phase, pedicle screw placement, and decompression with cage placement. RESULTS A clinical accuracy for screw placement within the pedicle (Gertzbein 0 or 1) of 94% was achieved. One screw violated the facet joint with a transarticular pathway. The screw head did not depress the facet in 54%. The use of fluoroscopy during navigation correlated with patient body-mass index (r=0.68, P<0.0001). The pedicle screw placement time corresponded to 36±5% of the total operative time of 117±11 minutes. A statistically significant decrease of 10 minutes in operative time was observed between the first and last 10 procedures which corresponded to the pedicle screw placement time decrease (48±9 vs. 38±7 min, P=0.0142). The learning curve model suggests an ultimate operative time decrease to 97 minutes. CONCLUSION Augmented reality surgical navigation can be clinically used to place percutaneous screws during minimally invasive TLIF. However, the lack of tracking of the location of the device requires intraoperative fluoroscopy to monitor screw insertion depth especially in obese patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Roberto L Cazzato
- Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Rami Nachabe
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, The Netherlands
| | - Anindita Chatterjea
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, The Netherlands
| | | | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
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A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:46-55. [PMID: 34333714 DOI: 10.1007/s00586-021-06948-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Navigation is becoming more useful in percutaneous pedicle screw fixation (PPSF). The aim of this study was to compare the efficiency, fluoroscopic time, accuracy, and clinical outcomes of PPSF with a novel electromagnetic navigation (EMN) system for thoraco-lumbar (TL) fractures with those of PPSF with conventional C-arm fluoroscopic (CF) guidance. METHODS A retrospective study was conducted. A total of 162 screws were implanted in 29 patients with the assistance of the EMN system (EMN group), and 220 screws were inserted in 40 patients by using CF guidance (CF group). The duration of surgery, placement time per screw, fluoroscopic time per screw, accuracy of pedicle screw placement, and clinical outcomes were compared between the two groups. RESULTS The duration of surgery and placement time per screw in the EMN group were significantly lower than those in the CF group (P < 0.05). The fluoroscopic time per screw in the CF group was significantly longer than that in the EMN group (P < 0.05). The learning curve of PPSF in the EMN group was steeper than that in the CF group. The accuracy of pedicle screw placement in the EMN group was more precise than that in the CF group (P < 0.05). The VAS scores in the EMN group were significantly lower than those in the CF group at one-week postoperatively (P < 0.05). CONCLUSION Compared with PPSF by using conventional fluoroscopic guidance, PPSF with the aid of the EMN system can increase the efficiency and accuracy of pedicle screw placement and reduce the fluoroscopic time.
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Carson T, Ghoshal G, Cornwall GB, Tobias R, Schwartz DG, Foley KT. Artificial Intelligence-enabled, Real-time Intraoperative Ultrasound Imaging of Neural Structures Within the Psoas: Validation in a Porcine Spine Model. Spine (Phila Pa 1976) 2021; 46:E146-E152. [PMID: 33399436 PMCID: PMC7787186 DOI: 10.1097/brs.0000000000003704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 08/13/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Experimental in-vivo animal study. OBJECTIVE The aim of this study was to evaluate an Artificial Intelligence (AI)-enabled ultrasound imaging system's ability to detect, segment, classify, and display neural and other structures during trans-psoas spine surgery. SUMMARY OF BACKGROUND DATA Current methodologies for intraoperatively localizing and visualizing neural structures within the psoas are limited and can impact the safety of lateral lumbar interbody fusion (LLIF). Ultrasound technology, enhanced with AI-derived neural detection algorithms, could prove useful for this task. METHODS The study was conducted using an in vivo porcine model (50 subjects). Image processing and machine learning algorithms were developed to detect neural and other anatomic structures within and adjacent to the psoas muscle while using an ultrasound imaging system during lateral lumbar spine surgery (SonoVision,™ Tissue Differentiation Intelligence, USA). The imaging system's ability to detect and classify the anatomic structures was assessed with subsequent tissue dissection. Dice coefficients were calculated to quantify the performance of the image segmentation. RESULTS The AI-trained ultrasound system detected, segmented, classified, and displayed nerve, psoas muscle, and vertebral body surface with high sensitivity and specificity. The mean Dice coefficient score for each tissue type was >80%, indicating that the detected region and ground truth were >80% similar to each other. The mean specificity of nerve detection was 92%; for bone and muscle, it was >95%. The accuracy of nerve detection was >95%. CONCLUSION This study demonstrates that a combination of AI-derived image processing and machine learning algorithms can be developed to enable real-time ultrasonic detection, segmentation, classification, and display of critical anatomic structures, including neural tissue, during spine surgery. AI-enhanced ultrasound imaging can provide a visual map of important anatomy in and adjacent to the psoas, thereby providing the surgeon with critical information intended to increase the safety of LLIF surgery.Level of Evidence: N/A.
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Affiliation(s)
- Tyler Carson
- NeuroSpine Institute, Palmdale, CA
- Riverside University Health System, Department of Neurosurgery, Moreno Valley, CA
| | | | | | | | | | - Kevin T. Foley
- Semmes-Murphey Clinic & Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN
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Guidelines for navigation-assisted spine surgery. Front Med 2020; 14:518-527. [PMID: 32681209 DOI: 10.1007/s11684-020-0775-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/14/2020] [Indexed: 10/23/2022]
Abstract
Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues. Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement. Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern. Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery. However, no clinical guidelines have been published for this relatively new and fast-growing technique, thus potentially limiting its adoption. In accordance with the consensus of consultant specialists, literature reviews, and our local experience, these guidelines include the basic concepts of the navigation system, workflow of navigation-assisted spinal surgery, some common pitfalls, and recommended solutions. This work helps to standardize navigation-assisted spinal surgery, improve its clinical efficiency and precision, and shorten the clinical learning curve.
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Li Q, Chen B, Chen R, Yu Y, Jiang L, Fan X. Comparison of the perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21064. [PMID: 32664123 PMCID: PMC7360262 DOI: 10.1097/md.0000000000021064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Computer navigation technology is gradually applied to the placement of pedicle screws, but its security and effectiveness still lack of high-quality evidence-based medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials to investigate the accuracy and effectiveness of computer navigation vsersus fluoroscopy guidance for pedicle screw placement. METHODS All study protocols adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), The excerpta medica database, Web of Science (science and social science citation index), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, WanFang, Chinese Biomedical Literature Database will be searched for relevant articles up to 18 April, 2020. We will include randomized controlled trials of computer navigation and fluoroscopy guidance for pedicle screw placement. The Cochrane Handbook (v6) will be used for assessment of study bias and reliability, and a meta-analysis will be performed using STATA 16.0. The main outcome will be the proportion of accurate implanted screws. Additional outcomes including: overall complication rate, radiation dosage, length of surgery, length of stay, estimated blood loss. RESULTS The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals. CONCLUSION We will evaluate the accuracy and other perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement. TRIAL REGISTRATION NUMBER PROSPERO 2020 CRD42020172087.
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Cranial facet joint injuries in percutaneous lumbar pedicle screw placement: a matched-pair analysis comparing intraoperative 3D navigation and conventional fluoroscopy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:88-96. [PMID: 32462309 DOI: 10.1007/s00586-020-06467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 04/01/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The violation of the cranial adjacent facet is a frequent complication in lumbar instrumentations and can induce local pain and adjacent segment disease. Minimally invasive screw implantation is often stated as risk factor in comparison with open approaches. Percutaneous pedicle screw placement (PPSP) can be performed using single X-ray images (fluoroscopy) or intraoperative 3D navigation. The study compares top-level screws in percutaneous lumbar instrumentations regarding facet violations and screw pedicle position using navigation or fluoroscopy. METHODS Patients after lumbar PPSP were retrospectively separated according to the intraoperative technique: navigation (NAV) or fluoroscopy (FLUORO). Two blinded investigators graded the top-level screws regarding facet violations and pedicle breach in postoperative CT scans. Subsequent matched cohort analysis was performed for comparable groups. RESULTS Evaluating 768 screws, we assessed 70 (9.1%) facet violations. Overall, 186 (24.2%) screws were implanted using navigation. There was no significant difference in the rate of facet violations between both imaging groups (NAV 19/186, 10.2%, FLUORO 51/582, 8.8%, p = 0.55). Totally, 728 (94.8%) of all screws showed a correct pedicle position. Most of the 40 unfavorable pedicle positions were placed by fluoroscopy (NAV 4/186, 2.2%, FLUORO 36/582, 6.6%, p = 0.03). The matched cohorts verified these results (facet violations: NAV 19/186, 10.2%, FLUORO 18/186, 9.7%, p = 0.55; pedicle penetrations: NAV 4/186, 2.2%, FLUORO 12/186, 6.9%, p = 0.04). CONCLUSIONS Both intraoperative imaging techniques allow lumbar PPSP with low rates of cranial facet violations if the surgeon intends to preserve facet integrity. Navigation was superior concerning accurate pedicle screw position, but could not significantly prevent facet violations.
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